SpectrumSociety for Healthcare Strategy and Market Development® March/April 2011

SpectrumSociety for Healthcare Strategy and Market Development® May/June 2012

To view current career opportunities,visit us at baystatehealth.org/jobs.Baystate Health is an equal opportunity employer committedto an inclusive and diverse workforce. EOE/AA

Yes, that means you.A promising career starts with being accepted for who you are. AtBaystate Health, we call this inclusion. Baystate Health is one of onlysix health systems in the country to be honored with the Human RightsCampaign Foundation's “Leader in LGBT Healthcare Equality” award.For having specific policies and nondiscrimination standards, BaystateHealth is recognized as a leader committed to creating a culture thatpromotes diversity and inclusion.At Baystate Health, each and every one of us has a unique contributionto make to the field of health care. We'd be proud to include yours.

includes everyone.

Liz, Baystate Health employee

Finding innovation can be as simple as including everyone.

(Continued on next page)

I’m proud to say that my orga-nization has done some excellent work for Baystate Health in western Massa-chusetts. As a result of our success with earlier projects, Baystate’s chief diversity officer, Visael “Bobby” Rodriguez, asked to partner with us to promote Baystate Health’s diversity initiatives.

Now, as a white male of European de-scent living in rural Pennsylvania, I’m all about diversity. The truth is, I had no idea what to expect when I first met with Bobby. My perception of diversity was very limited, revolving around skin color and religious practices. But Bobby’s presentation blew me away. He challenged my attitudes on everything from race to age and led me to a major epiphany: Innovation happens only when new ideas are brought to the table, and happens only when everyone—regard-less of who they are—is given a voice. And

Need to Innovate? Diversify.

that’s what diversity is all about.It’s one thing to claim a diverse workforce

or patient population. It’s another thing to nurture a genuine culture of inclusion—one in which everyone feels welcomed and valued, one in which everyone can contrib-ute to his or her fullest potential to achieve organizational objectives. This is where the rubber meets the road. Organizations that understand and address the unique perspec-tives held by their entire patient and employ-ee population can gain significant ground.

Of course, everyone likes to do the right thing, and we all know including people and fostering diversity is the right thing to do. But organizations don’t make deci-sions based on “feelings.” They look at the bottom line. In 2000 a midsize health-care services company asked Gallup to design a survey to measure inclusiveness (Ludwig and Talluri 2001). The results

showed that attitudes about inclusiveness varied across the organization, and that workgroups with the lower inclusiveness scores had lower productivity and reten-tion scores than those with higher levels of inclusiveness. Studying the measurable links between inclusiveness and positive business outcomes (retention, profitability, and productivity) reveals the business value of workforce diversity.

Are you struggling to understand how this can affect your organization? Health-care is notoriously conservative, and di-versity may not be a priority during this time of ACOs and physician shortages. But it should be. Bobby provided me with several studies and data points that proved this point. The Gallup Workplace Study referred to above showed that a culture of diversity and inclusion provided a 39 percent increase in patient satisfaction, a 22 percent increase in productivity, a 22 percent decrease in employee turnover, and ultimately a 27 percent increase in profitability. Your organization can’t afford to disregard these numbers.

Changing the Culture So how does one employee go about chang-ing an organizational culture? It starts with understanding and learning. Each of us needs to realize that even though we feel most comfortable being around people similar to ourselves, it’s not always best for our team, department, or organization. We’ve all heard the expression that if we all looked the same, the world would be a very boring place. Well, if we all took the same direction when trying to solve challenges, some challenges would never get solved.

The second thing we need to do is care. We need to go beyond understand-ing the importance of diversity and an environment that promotes inclusion and genuinely care enough to make it

W O R K F O R C E

2 Spectrum | May-June 2012

Society for HealthcareStrategy and Market Development®

PresidentMaria RoyceSenior Vice President, Planning and Community Development WellSpan HealthYork, PA

President-electHolli SallsVice President, Public Relations, Marketing, and Physician Services Northwestern Memorial HospitalChicago, IL

Immediate Past PresidentTess NiehausMarketing Strategy ConsultantSt. Louis, MO

Executive DirectorLauren A. BarnettSociety for Healthcare Strategy andMarket DevelopmentChicago, IL

EditorKaren W. PorterSociety for Healthcare Strategy andMarket DevelopmentChicago, IL

Design and Layout

Spectrum is the bimonthly newsletter of and a membership benefit for members of the Society for Healthcare Strategy and Market Development®. SHSMD welcomes unsolicited manuscripts, which will be used on a content and space-available basis. Preferred article length is from 1,200 to 1,500 words, and graphics (figures, tables, photos) and suggestions for sidebars are welcome. Please e-mail articles to kporter@aha.org.

The editorial office is located at:155 North Wacker, Suite 400 Chicago, IL 60606Phone: 312.422.3888Fax: 312.278.0883E-mail: shsmd@aha.org Website: www.shsmd.org

Opinions expressed in these articles are those of the authors and do not necessarily reflect the opinions of SHSMD or the American Hospital Association.

©2012, Society for Healthcare Strategy and Market Development. Reprinting or copying is prohibited without express consent from SHSMD.

Need to Innovate? Diversify(Continued from page 1)

happen. We need to realize that if we don’t start the process internally, it will never get started externally.

Finally, and most important, we need to act. It’s not enough to understand and care if we are not willing to put that understanding and caring into action. When you’re putting together a team to solve a problem, take a little more time in selecting its members. Make sure to add different age groups, people with different backgrounds, men and women. Make sure to instruct them to solve the problem as a team and to start off with a brainstorming session in which everyone’s opinion and ideas are welcome. No wrong ideas, only great input.

We’re all looking for people who can do great things—but do they all have to achieve them the same way you did, or can their diverse backgrounds and unique challenges and victories benefit your de-partment and organization in ways you never could have seen?

In short, innovation happens when you

combine ideas from intersecting fields of study, disciplines, and cultures. Break-throughs occur when different people from different fields come together to find “a place for their ideas to meet, collide and build on each other” (Johansson 2004).

Innovation can be elusive, but it’s the life-blood of successful organizations. Are you simply falling in line and wondering why the direction never changes? Then maybe it’s time to review your attitudes and poli-cies about diversity.

Written by:Shawn Kessler, Senior Strategist

Aloysius Butler & Clark

Bloomsburg, PA

570.784.9604skessler@a-b-c.com

www.a-b-c.com

& Another Thing (blog): blog.a-b-c.com

ReferencesJohansson, F. 2004. The Medici Effect: Breakthrough Insights at the Intersection of Ideas, Concepts & Cultures. Boston: Harvard Busi-ness Press.

Ludwig, J., and Talluri, V.S. 2001. “To Leverage Diversity, Think In-clusively.” [Online information; retrieved 3/20/12.] gmj.gallup.com/content/778/leverage-diversity-think-inclusively.aspx

The Story Behind Baystate’s Diversity CampaignBaystate Health’s Bobby Rodriguez and AB&C’s Shawn Kessler (Baystate Health’s provider recruitment agency) were featured speakers at last year’s SHSMD Annual Conference in Phoenix, AZ. Everyone wanted to know how Baystate Health’s sensitive, open-minded “diversity” campaign became so successful.

“It all started with a culture of inclusion—a commitment to creating a healthcare environment in which employees and patients of all backgrounds, genders, orientations, nationalities, and cultures can feel welcome and have their voices heard,” says Bobby Rodriguez. The risk-taking campaign featured more than 30 real employees. It spoke honestly about Baystate Health’s appreciation for, and outreach efforts to, the diverse communities from which its prospective employees come.

The recruitment campaign harnesses the diversity of current employees by featuring them in ads aimed at their own communities. For example, LGBT employees can be found in ads appearing in The Rainbow Times, an LGBT publication, while African-American employees are featured in ads in Point of View news magazine and Urban League sponsorship ads. In addition, the ad has been translated into Russian, Spanish, and Vietnamese for use with those audiences. “The response has been staggering and inspiring, exceeding our expectations in both the number and the quality of job candidates,” Shawn Kessler says.

Baystate Health isn’t shy about sharing its views on diversity with potential providers and patients, too, encouraging them to treat others and expect to be treated with dignity, respect, and acceptance. The health system has been honored two years running by the Human Rights Campaign Foundation, earning the top award as “Leader in LGBT Healthcare Equality” in 2011.

The recognition is not lost on Bobby Rodriguez. “It validates our belief that being an organization that supports diversity gives us a significant advantage over other healthcare systems in our area.” It’s a story that continues to have happy endings for Baystate Health patients and caregivers alike.

May-June 2012 | Spectrum 3

More-sophisticated questions adapted from the packaged-goods industry can help healthcare marketers discover the “why” behind the “how” when measuring likelihood to use again and to recommend to others.

Traditionally, likelihood to use again (i.e., loyalty) and likelihood to recommend to others (i.e., advocacy) have been measured using a simple 5- or 10-point rating scale. But do these metrics provide useful information beyond how a hospital scored? That is, do they provide any insight into why the hospital received the score it did and what it can do about it? Typically not. We have explored how other industries view loyalty and advocacy and have developed a different way of asking these questions that uncovers the “why” as well as the “how.”

Share of Wallet: A New Way to Measure LoyaltyThe traditional method of measuring hos-pital loyalty is an interval-level scale (for ex-ample, “On a 1–10 scale, where 10 means very likely and 1 means very unlikely, how likely are you to use this hospital again?”). So when your organization gets a mean score of 8.2 (on a 1–10 scale) on likelihood to use again, is that good? What exactly does it mean? What can you do with that?

Packaged-goods companies refer to loyalty as share of wallet. They look for how many times out of X times someone purchases their product (for example, “Think about your next 10 purchases of cereal. How many times out of 10 will you purchase Brand X?”). The resulting score tells the company’s marketers not only the likelihood the customer will purchase their brand again but also, quantitatively, how loyal customers are to the brand. They can also ask

what other brands the customer is buying to understand who their competitors are and how many are in the choice set.

This is not even close to the typical like-lihood-to-use-the-hospital-again scale. We have attempted to integrate this thinking into a new type of loyalty question, one that measures not just “will you use us again” but also “for how many types of situations.” Here is the wording of the question:

Q: When you think of all the reasons why you would use {HOSPITAL} in the future, would you say you have good reasons to use this hospital again for____ ?

Table 1 illustrates just how different “share of wallet”–type loyalty is and how useful this type of information can be. Clearly, Hospital F has the strongest level of loyalty, with six in ten recent patients

Loyalty (Total)

Hospital A

Hospital B

Hospital C

Hospital D

Hospital E

Hospital F

Every medical situation (20%) 38% 36% 9% 10% 4% 61%

Most situations, but not all (39%) 30 52 39 32 64 20

Some medical situations (25%) 24 9 25 28 11 12

A few specific situations but

that’s it (11%)4 1 17 18 11 7

Nothing/would not use hospital again (3%) 5 1 5 10 6 0

Not sure (2%) 0 1 6 2 4 0

Table 1. Patient Responses to L0yalty Questions by Hospital

(Continued on next page)

Recent utilization

Source: Klein & Partners

M A R K E T R E S E A R C H

New Ways of Looking at Loyalty and Advocacy

4 Spectrum | May-June 2012

Source: Klein & Partners

saying they would use the hospital again for everything. But while the same proportion of recent patients of Hospitals A and B say they would use them again for “every” medical situation, patients of Hospital B are significantly more likely to say they would use it again for “most” situations, while Hospital A’s patients are more likely to be more comfortable using it again for some or just a few specific situations.

What is different about these two hos-pitals? Is it the patient mix? The patient experience? The hospital’s reputation for certain procedures? The real power to make specific improvements comes when two key follow-up questions are asked:

●● Why are you not comfortable using this hospital again for every medical situation?

●● For which medical situations would you not be comfortable going to Hospital X?

Advocacy (Behavior vs. Intentions)The traditional method of measuring advo-cacy is an interval-level scale (for example, “On a 1–10 scale, where 10 means very likely and 1 means very unlikely, how likely are you to recommend Hospital X to others?”). Such scales have one thing in common: They all ask about future behavioral intentions—that is, how likely a person is to recommend your hospital in the future. But with so many things that can happen between now and then, how confident can we be in a future

number like that? If your organization has a recommend-intention score of 8.4 on a 1–10 scale, is that good? What can you do with it?

Our experience in the packaged-goods industry led us to develop an advocacy metric that brings actual behavior into the equation, blended with reasons people would not recommend (people are able to tell you in a more concrete fashion why they will not do something than why they will).

Here is the wording of the question:Qa: Have you ever recommended {HOSPITAL} to anyone?

1.�Yes

2.� No (GO TO NEXT QUESTION)

3.� Not sure

Qb: Have you NOT recommended {HOSPITAL} because…

1.� you just haven’t had the opportunity but definitely would if it came up, or

2.� you don’t want to recommend this hospital because you don’t like something about it, or

3.� you’re just not someone who recom-mends companies to others whether you like them or not

4.� not sure

Table 2 illustrates how useful this infor-mation can be. Eight in ten recent patients have already recommended Hospitals B and F to others. By contrast, Hospitals C, D, and E have much lower levels of

recommendation. But there are big differ-ences among them. Four in ten patients of Hospital E just aren’t the type of person who recommends companies to others (yes, there are many folks like that out there, and the traditional scale question does not ac-count for them!), while Hospitals C and D have a real problem—about one-third of their patients have not recommended them because they specifically do not want to. Instead of having a scale question that gives us one aggregate number—the mean, for example—we have several key categories of respondents we can profile. For example, what do the 36 percent of Hospital C’s patients who didn’t like something about the hospital look like? What about their experience didn’t they like? See how use-ful this type of advocacy question can be?

Market Barriers: When Life Gets in the Way of PreferenceOftentimes, preference does not lead to utilization. Why not? If someone prefers your brand, why wouldn’t they choose you? Let’s take a look at what we call market bar-riers and see how they can get in the way of preference’s connection to utilization.

First, a few definitions. Brand strength can be thought of as “pulling” the brand through distribution channels, while mar-ket strength can be thought of as “pushing” the brand through distribution channels. What do we mean by push/pull?

Pull. A strong brand creates interest in itself through marketing, communi-cation, and experience efforts that make

Table 2. Patient Responses to Advocacy Question, by Hospital

New Ways(Continued from page 3)

Advocacy (Total) Hospital A Hospital B Hospital C Hospital D Hospital E Hospital F

% Yes (53%) 65% 83% 25% 36% 30% 82%

Didn’t recommend because didn’t like something about hospital (15%) 7 2 36 30 10 0

Didn’t recommend because not the kind of person who recommends (10%) 12 4 10 5 41 10

Didn’t recommend because haven’t had the opportunity to, but would (9%) 6 4 5 8 11 2

Didn’t recommend and not sure why (13%) 10 7 24 20 8 6

Recent utilization

May-June 2012 | Spectrum 5

people want to use it (again). Joel English, managing director of a healthcare mar-keting communications agency based in Milwaukee, calls the resulting preference brand craving. Essentially, with this strat-egy, consumers “pull” the brand through distribution channels with their interest or satisfaction. Brands accomplish this by creating a strong brand promise and expe-rience—that is, through brand strength.

Push. Consumer attraction to a hospital brand can be undermined if the service or facility is not readily available or some other hurdle gets in the way of consumer interest and behavior—that is, if there is some market barrier. For example, physi-cians without a strong relationship with the hospital in question can undermine a brand in which consumers are interested; likewise, a hospital that isn’t in key insurer networks or has inconvenient locations can cause people to go elsewhere. These examples of lack of market strength are a major reason consumer preference doesn’t always lead to increased market share.

Although preference and utilization ques-tions have been around for a long time, met-rics to assess the impact of market barriers have been underutilized. When preference

does not lead to market share, it may simply be a matter of “life getting in the way.” The best intentions of any organization can be undermined when barriers emerge at the time of hospital choice. Your hospital can create strong brand craving among consum-ers, but when a patient goes to his or her physician and says, “Doctor Smith, I would like to go to Hospital A,” and Doctor Smith replies, “I think you would be better off at Hospital B because…,” most often that patient still says, “OK, you’re the doctor.”

We have developed a series of ques-tions addressing the impact that market barriers can have on preference. For the hospital that is most preferred among nonpatients, we ask:Q: If you wanted to go to {HOSPITAL}, are there any factors—such as inconvenient loca-tion, health insurance restrictions, physician not admitting there, scheduling hassles, or anything else you can think of—that could hinder you in using this hospital?

If the respondent says yes, we ask: Q: What would you say is the single biggest barrier to using {HOSPITAL}?

Figure 1 illustrates how market barriers can have an impact on people’s preference. For example, Hospital B has a much larger

market share than Hospital A, even though Hospital B’s overall preference among nonpatients is much lower. Notice that barriers-to-use for Hospital A are much larger than those for Hospital B, contrib-uting to a lower market share.

Conversely, a lack of market barriers—that is, market strength—can positively influence market share even when prefer-ence is low. In Figure 1, Hospital C has the largest utilization share in this market, yet its overall preference among nonpatients is the lowest of all competitors. For Hospital C, having almost no market barriers—for example, it is the most conveniently lo-cated—creates market strength, which can overcome weaker brand strength. However, over time, competitors can combat market strength and use weaker brand strength against you. Successful brands create both market and brand strength.

Written by: Rob Klein, President

Klein & Partners

Orland Park, IL

630.455.1773rob@kleinandpartners.com

www.kleinandpartners.com

Even with less brand appeal, Hospital B has a larger market share than Hospital A because it has much lower perceived barriers to use. This illustrates how location-sensitive people in this market are. Hospital A’s barrier is mostly location driven, while Hospital B’s barrier is more insurance driven. Source: Klein & Parners

Per

ceiv

ed b

arri

ers

in u

sing

Most preferred hospital among nonpatients of that hospital

Figure 1. Impact of Market Barriers on Correlation Between Performance and Utilization

Bubble size = market share (i.e., hospital most recently used)

0

10

10 20 30 40

20

30

40

50

60

70

80

Hospital D; 11

Hospital E; 10

Hospital C; 28

Hospital B; 23

Hospital A; 13

Location, location, location sometimes beats a lack of brand strength.

6 Spectrum | May-June 2012

How to create favorable word of mouth by using patients’ own words in believable video testimonials.

When patients are asked how they learned about a hospital or surgical procedure, most say they heard about it through “word of mouth.” When patients say they heard about something by word of mouth, they either heard someone they know talk about a health-care provider, or they asked someone they respect and trust to recommend a hospital, a physician, a physician practice, a treatment or procedure, a medication, or a medical device.

Two-way, face-to-face word of mouth cannot be bought or packaged. It comes, unedited, from the mouths of people who had a very good experience or a very bad experience with a hospital, practice, or doc-tor. As much as we might like to control it, the only control we have over most word of mouth from patients is by ensuring that we have doctors who work together as a team, trained supporting staff, and consistently positive clinical and functional outcomes.

Quality of word of mouth is directly re-lated to the quality of the product. Market-ing and hospital participation in social media may support positive word of mouth, but it does not produce it. The patient’s own hospital experience, good or bad, has a sig-nificant potential for powerful positive—or negative—word of mouth.

A Hierarchy of Word-of-Mouth Effectiveness The most effective form of word of mouth is face-to-face, where a discussion on a topic

can be conducted complete with body lan-guage, facial gestures, and the senses of sight, touch, hearing, smell, and taste. Face-to-face is a rich interactive experience. It is no wonder we want to see and hear physicians, friends, and loved ones face-to-face rather than having to settle for a telephone call or other means of communication.

As a substitute for face-to-face interaction, the second most effective word of mouth is via two-way video with voice telecon-ference or Skype conversation, where you can see a person’s face and hear his or her words. One-way video with voice can be created for transmission one-on-one to a specific recipient.

The third most effective word-of-mouth experience is by two-way voice phone, which allows voice inflections and vary-ing emphasis on words, although the visual component is noticeably lacking. One-way voice phone is, for example, a voice-mail message.

Less effective is the written word in a message transmitted from one person to another, whether in a letter, an e-mail, or a text message. No voice, facial, or body cues are communicated, sometimes leading to misunderstanding as to what the author intended.

To compensate for the lack of voice or body cues, one-on-one written word mes-sages often are accompanied by punctuation marks, such as !, or emoticons, such as , in an attempt to express a feeling. Cursive writ-ing in a letter conveys complex feelings that the typed word in an e-mail or text cannot.

The written word can also be broadcast,

as in a blog, an entry on a social media site, or an electronic or paper document, such as an e-book or a printed book.

Other surrogates for face-to-face are voice and video broadcasts —radio, television, or video messages that are broadcast to many rather than transmitted to one. Testimonials may be broadcast on radio and TV, in pod-casts, and on sites like YouTube, although broadcasts are less likely than one-to-one transmission to be perceived as presenting believable and reliable information.

One of the least effective surrogates for word of mouth, as well as the most socially and physically distant, is Internet social me-dia. Over half of Internet users say little or none of the information on social networking sites is reliable, according to the 2011 Digital Future Report published by the Center for the Digital Future at the USC Annenberg School for Communication & Journalism.

Enter the Video TestimonialOne-way video broadcast testimonials can be effective substitutes for face-to-face word of mouth when the person speaks from personal experience, is not paid, and is using his or her own words.

Paid actors and celebrities are often used to promote health-related products and services in audio and video commercials as well as print advertising. However, viewers recognize these people are compensated to promote a product or service, so their credi-bility is lower than that of unpaid customers.

Many hospitals use patient testimonials in promoting treatment programs, but they often script the patients, have them say the name

Word of Mouth and the Patient Testimonial

Thumbnails of video testimonials featuring three former patients of Baylor Health Care System. Note that the viewer does not know which hospital is sponsoring the testimonial until the last frame. No hospital name is given in voice or graphics during the testimonial.

M A R K E T I N G C O M M U N I C A T I O N S

May-June 2012 | Spectrum 7

of the hospital, or use so many production values—for example, doing the patients’ hair and make-up and having them wear clothing they wouldn’t normally wear—that the pro-duction itself lessens the credibility of the pa-tient’s words and lowers respect for the hospital sponsor. A testimonial should be perceived as a personal message, not a commercial.

Creating Effective Video Testimonials The most effective testimonials are those in which the patient wears everyday clothing from his or her closet, uses his or her own words and style of speech, and talks about his or her personal experience without directly promoting and naming the hospital. The patient talks about the improvements in his or her life. The only identification with the hospital is in a tagline at the end of the video.

This is the approach used by Baylor Health Care System in Dallas. The effect on viewers is that of being dropped into an intense conversation with a patient who is re-counting his or her full experience, all in less than 30 seconds. The patients are unscripted, and the use of black-and-white video—cou-pled with an intense focus on their faces and hands—helps to build interest and drama. The ads have the effect of word of mouth and have measurably increased Baylor’s aware-ness levels in one of the most competitive markets in the United States.

Recently Baylor added the phrase “Real Patients. Real Stories” to reinforce to view-ers upfront that there are no actors and the stories come from the patients, not an agency scriptwriter. (Go to YouTube.com and enter “Baylor Health Care” for examples.)

Videos of patients talking are best cre-ated using any video camera and tested with viewers before investing in full production. The test is whether the viewer perceives the patient as honest and unprompted, as close

in believability to a face-to-face experience as possible. Tests are done one-on-one, letting the viewer see the video, talk about his or her feelings about the patient and the message, and then complete a quantitative question-naire on believability and the messages the patient is conveying. Only after this is the video professional produced.

Baylor tracks the effectiveness of the video when it is on television or digital media, such as YouTube and Facebook, by asking callers to our 800 number how they heard about the treatment, such as bariatric surgery; when they heard about it; whom they heard it

from; and what they heard. We also track whether callers provide unaided mentions of having seen any videos on the topic on television or the Internet.

Although a face-to-face recommenda-tion is the most believable and perceived as most reliable, this type of video testimonial is next best to having a friend recommend a procedure face-to-face.

Written by: Emerson Smith, PhD, Medical Sociologist

Metromark Healthcare Research Center

Columbia, SC

803.256.8694

emsmith@metromark.net

www.metromark.net

Jennifer Coleman, Senior Vice President,

Consumer Affairs Baylor Health Care System

Dallas, TX

214.820.1900jennifco@baylorhealth.edu

www.baylorhealth.com

Ask Any Patient: Another Way to Create Word of Mouth If more patients talked about their hospital experiences and spread good word of mouth in the community, there would be no need for video testimonials. But so many who have had excellent hospital experiences tell no one after they have had a successful inpatient or outpatient procedure. It often takes someone asking a former patient directly to get the patient to say anything—good or bad—about a hospital, treatment, or doctor. For many, it takes prompting by their friends to get them to talk about their experience. Otherwise, they are not talking, not producing word of mouth.

Many hospitals have “ask-a-nurse” programs that provide callers free answers to health questions. Pharmaceutical companies have had great success selling prescription drugs by telling patients to “Ask your doctor.” Patients are likely to ask their doctors not only about an advertised drug, but also about a hospital or procedure. For a second opinion,

people often ask their friends, relatives, or coworkers to recommend a health provider, a medication, or alternatives to surgery, especially for diagnoses such as breast or prostate cancer for which a variety of treatment options are available.

In addition to using believable testimonials, hospitals should create and promote “ask any patient” word-of-mouth campaigns to get people to ask former hospital patients to tell people in the community about their experiences. Patients are full of detailed information and, when prompted, are ready to talk, some using positive words and others with negative comments.

Of course, if a hospital has safety, infection, staffing, or operational issues, those need to be resolved before inviting community residents to “ask any patient” about a recent experience there. How many hospitals are prepared to have an “ask any patient” campaign for the emergency department? The maternity department? Cardiovascular surgery? Or would the hospital need to rely solely on handpicked patients in a series of video testimonials?

8 Spectrum | May-June 2012

Anniversary Dinner QR Code Scan the QR code to see a short video about one extraordinary act of service celebrated at monthly employee forums at the Nebraska Medical Center.

Outrunning the BearIncreased focus on internal communication keeps Omaha hospital a step ahead.

The call comes into the emergency department: a rollover accident with mul-tiple injuries. Patients begin arriving on what is already a busy night. Staff spring to action. Tests are ordered, results are returned quickly. Operating rooms are booked. On-call physicians are paged and arrive in record time. In short, everything works the way it should. It’s what we, as healthcare workers, train for. After all, we must be at our best during the most difficult of circumstances. But what about the rest of the time?

Your communication strategy for ongo-ing challenges—sustained financial pres-sures, staffing model changes, even an across-the-board IT upgrade—is just as important. Imagine what could be accom-plished if you could harness even 60 percent

of the teamwork, cooperation, and commu-nication that occurs during an emergency situation at your hospital and focus it on everyday challenges.

A Time of Change There has never been a time when the health-care field has gotten more attention from government, the media, and the public. Additional cutbacks, greater performance expectations, and lower reimbursement are all we know for sure. Change is here, more is on the way, and we must be ready.

The people you need to have working together to overcome obstacles are looking for a sense of direction, the latest informa-tion, and, most important, reassurance. For the Nebraska Medical Center in Omaha, a strategic investment in internal commu-nications during uncertain times has not only rallied the troops, but enhanced the organization’s competitive position as well.

The Nebraska Medical Center’s StoryIn 2009 the economic crisis was headline news. Banking, real estate, manufacturing, and, yes, even healthcare were affected. Al-though the Midwest fared better than most of the nation, it was not immune to layoffs. Amid the turmoil, the Nebraska Medical Center devised a simple communication strategy. We said, “Let’s talk about it. Let’s be open and honest about the challenges facing us and enlist staff to help.”

When the first monthly all-employee fo-rum was held days after the Nebraska Medi-cal Center’s closest competitor announced layoffs and another made the decision to hold raises, you can bet attendance was high. With a capacity of about 500 people, the conference center was standing room only, with staff backed into a hall and all the way up a staircase.

Employees wanted to know: Were jobs safe? Would there be cutbacks? They wanted to hear what President and CEO Glenn A. Fosdick, FACHE, had to say. He told a story of two hikers who encounter a bear. When one hiker sits down to put on his running shoes, the other one says, “You’re crazy; you can’t outrun a bear!” The first hiker says, “I don’t have to outrun the bear, I just have to outrun you.”

The story garnered a few laughs and even more head nods as Fosdick continued. “It’s tough,” he said. “When I started my career over 30 years ago, there were 9,000 hospitals. Now there are 5,000. I know one thing for sure: Omaha will always need a hospital, and as long as we are in the front of the pack, we don’t have to worry.”

Each month staff on both day and night shifts get the latest figures on market share and patient satisfaction and talk about the hot-button issues of the day, such as Joint Commission survey results, new safety stan-dards, and the ever-popular question, “Are we getting raises this year?” “I tell them my number one job is to protect your job,” Fos-dick says, “but I can’t do that alone.”

Monthly forums at the Nebraska Medical Center draw a crowd of several hundred employees. Sessions are offered during the day and at night.

C O M M U N I C A T I O N

May-June 2012 | Spectrum 9

Reorganizing and Reemphasizing A move to monthly employee forums was just one of several bold moves made by the Nebraska Medical Center to bolster commu-nication efforts. “Three years ago, we made a conscious effort to redeploy our existing marketing budget and human resources to place a greater emphasis on internal commu-nications,” says Tadd Pullin, vice president of marketing, planning, and network opera-tions. “This included recruitment of a direc-tor and assignment of coordinators who have a dedicated focus in this area of expertise. This comprehensive approach has resulted in significantly greater engagement and has differentiated our organization from others.”

Over the past three years, the internal communications team has completed ap-proximately 3,300 projects. The team has become such an integral part of the hospital that rarely will a major committee be formed without a communications representative included. “It’s ideal,” says Pullin. “By having a seat at the table at the start of a project, the internal communications team is able to create a communication plan that takes all things into consideration. Our chances of success are a lot better than if we are brought in at the last minute to ‘fix’ something.”

It’s a Two-Way StreetCommunication doesn’t only mean telling; listening is just as important. The internal communications team has developed a num-ber of feedback mechanisms to allow two-way communication. Employees can submit ideas for efficiency online through the “I’ve

Got a Good Idea” program. They can also help shape the agenda for employee forums by submitting questions ahead of time.

Recognizing that not every staff member can attend employee forums, a number of low-budget, high-impact alternatives are used to reach employees, including:

●● Video podcasts: A three- to five-minute taped interview with the CEO about the monthly forum topics is prominently fea-tured on the hospital intranet.

●● Live broadcasts to off-site locations: Employee forums are filmed and broad-cast live each month to five locations.

●● Streaming video: Set up with the help of the IT department, a video streaming system lets staff members watch forums live from their work stations.

●● Night-shift pizza party: Serving pizza at 11 p.m. in conjunction with monthly forums ensures a full house and provides a valuable link to night-shift staff.

Turning Burden to OpportunityIncreased focus on internal communication has proved especially helpful with strategic changes. Currently, a coordinator from the team is dedicated full time to the hospital’s electronic health record replacement project, and another is assigned to an initiative to reduce the operational budget by 15 per-cent over three years. E-newsletters, talking points, and standing agenda items at leader-ship meetings ensure updates on strategic goals are cascaded down to staff.

Fosdick says, “I want people to look at these challenges and say, ‘If we can do this better than other people, it is going to be a differentiator.’ I want staff to look back at this time and not just say, ‘I survived that,’ but say instead, ‘I’m glad I went through that, I’m proud of how we handled that.’”

The PayoffAlthough it’s hard to put a price on the value of internal communication, it clearly is a con-tributor to employee morale and satisfaction. In the three years since investing in commu-nication, the Nebraska Medical Center has seen impressive results. Its annual workforce engagement survey results—benchmarked against 500 other hospitals—showed the

Tips for Drawing a Crowd at Employee Forums1.� Make it a regular event. Quarterly? Monthly? Decide how often you want to have employee forums, then make it happen. 2.� Talk it up. Send out web blasts with save-the-date reminders and teasers for the agenda items. Include reminders on the intranet and in newsletters. 3.� Lead by example. When leadership takes time to attend forums, it sends the message they are important.4.� Ask staff what they want to hear. Include a “submit a question for forums” button on your intranet, in e-newsletters, and in web blasts. Enlist the help of leadership from various areas to develop complete answers. 5.� Recognize and celebrate. Share extraordinary stories of customer service, and formally congratulate the participants. Recognize quality improvement efforts. Invite patients to share their positive experiences. 6.� Offer multiple ways to “attend.” Options include broadcasting to offsite locations, streaming the forum live on desktop computers, and recording and archiving the meeting on the intranet. A “CliffsNotes” version that includes a short interview with the CEO speaking about forum topics is also a way for busy staff to get key messages. 7.� Combine with other celebrations and launches. Hospitals are busy places. Use monthly employee forums to highlight awards and introduce campaigns. If you are planning an event to celebrate a recent accreditation or national ranking, combine the two. Launching a new ad campaign? Use employee forums to explain the strategy to your most important marketers. 8.� Don’t forget the night shift. Experiment to find a time that works best during the shift. Offer refreshments. Send out a special reminder to pagers at the beginning of the shift, or round on units beforehand to encourage attendance.

Dr. Nick Bruggeman shares a few remarks at employee forums. He was featured in a customer service video and recognized by President and CEO Glenn A. Fosdick for the extraordinary care he provided a young patient with a limb-threatening injury. (Continued on next page)

10 Spectrum | May-June 2012

The SHSMD Advantage Highlighting the benefits of membership

SHARE SHSMD—Become a SHSMD Member Ambassador!

S H S M D g r o w s stronger with each new member who joins. And there’s no better way to expand the com-munity of SHSMD members than by spreading the word to your peers in the healthcare strategy professions: marketing, PR and communications, and planning professionals—even your colleagues and friends at consulting firms and vendor organizations.

We make it easy for you to SHARE SHSMD. Go to www.shsmd.org/share, and let us know who you think could benefit from SHSMD membership. We’ll handle the rest.

Here’s the best part: In addition to helping to strengthen SHSMD, each name you provide gets you one en-try into a drawing this September for these awesome prizes:

●● Complimentary copy of By the Numbers: Benchmarking Study on Healthcare Marketing/ Communications (4th edition) ($85 value)

●● American Express gift card ($150 value)

●● Complimentary registration to a SHSMD U Online Course of your choice ($250 value)

●● American Express gift card ($350 value)

●● Complimentary registration to SHSMD’s 2012 Annual Conference in Philadelphia ($795 value)

Visit www.shsmd.org/share to learn more, and SHARE SHSMD today!

organization outperforming the “Top Box” benchmark in every category. In the “Best in Class” category, the organization outperformed the benchmark in 12 of 27 categories. Feedback about pride in the organization was nearly 30 percent above the industry benchmark. “I believe I am working at Omaha’s best medical facility and will look forward to a long relation-ship with this company and its leaders,” wrote one employee.

The feeling carries over into market share. Since 2008, the system’s market share has grown from 27.5 percent to 33 percent. Regional discharges have increased more than seven percentage points. But in perhaps the best indicator of all of employee morale, employees are literally buying the brand. An on-campus store that sells hospital logowear does a booming business of over $230,000 in sales per year.

Key to the FutureWhile there are many uncertainties in healthcare today, at the Nebraska Medical Center one thing is certain: Once a month employees can expect an update straight from the guy in charge. At a recent employ-ee forum, the organization’s new external website was launched, and employees got a virtual tour of the new features.

“For me it’s like a pulse check on what’s going on in the organization,” says Nicole Deremer, RN. “It puts Glenn closer to the average employee, like leadership is in this right along with us.”

“You have the ability to control your own destiny,” Fosdick tells employees this particular day. “Other industries may not have a choice. If you are a steelworker, you can’t control the price of steel. But you (as a healthcare worker) can impact the care our patients receive and how they feel about us.”

Written by:Crista Madsen, Director of

Corporate Communications

The Nebraska Medical Center

Omaha, NE

402.552.2449cmadsen@nebraskamed.com

www.nebraskamed.com

B R I E F S

Outrunning the Bear (Continued from page 9) SHSMD Datebook

May 14: Deadline for nominations, 2012 Award for Individual Professional Excellence

May 14–25: SHSMD U online course: “Healthcare Marketing Plans That Work,” with David Marlowe

May 21–June 1: SHSMD U online course: “An Introduction to Payment Reform Models and Analytics,” with David Gray, David Jackson, and Kevin Miller

June 4–15: SHSMD U online course: “Mastering Marketing Communications,” with Joel English

June 20: SHSMD U webcast: “Mission Leads to Margin,” with Jonathan Goble

July 9–20: SHSMD U online course: “Healthcare Market Research,” with Rob Klein

July 9–20: SHSMD U online course: “Segmentation Under New Payment Models,” with Jennifer Marshall and Dan Savage

July 16–27: SHSMD U online course: “Social Media Beyond the Basics: Strategy, Value, and the Future of Social,” with Ben Dillon and Dean Browell

July 31: Deadline for early-bird Annual Conference registration

August 25: Cutoff date for reservations at the Philadelphia Marriott Downtown (800.320.5744)

August 31: Deadline to vote for 2013 President-elect and Directors

September 19–22: “Connections 2012,” SHSMD Annual Educational Conference and Exhibits, Philadelphia Marriott Downtown, Philadelphia

October 1–12: SHSMD U online course: “Putting Your Strategic Plan to the Test,” with Gita Budd

November 8–9: “2012 SHSMD Executive Dialogue,” Conrad Hotel, Chicago

For more information on these and other professional development opportunities, go to shsmd.org.

May-June 2012 | Spectrum 11

T H E T I G H T R O P E W A L K E R # 1 2

Every issue Rick Wade presents a real-life scenario much like one you might encounter in your own organization and asks how you would handle it. Readers are invited to respond on “The Tightrope Walker” click poll on www.shsmd.org/tightrope. Rick, formerly senior vice president for strategic communications at the American Hospital Association, works with hospital and health system leaders who are coping with change, innovation, or crisis.

Whose Money Is It Anyway?

It’s Friday. You’re about to leave a little early when you are summoned to the CEO’s office. His trusted assistant, Henri-etta, is not at her sentinel spot when you arrive. In her place is someone you vaguely recognize from down the hall.

“Hi, I’m Lisa, the VP for communica-tions. I was asked to come up right away.” The assistant picks up the phone and a few seconds later says, “Go right in.”

Four pairs of eyes hit you as you enter the room: the hospital’s legal counsel, the vice chair of the board, the chief financial officer, and the chief operating officer.

“Sit down, Lisa,” the COO sighs. “It’s going to be a long weekend. Fred, as our attorney, you seem to have all the pieces of the story in order. Why don’t you brief Lisa?”

Fred sighs. “As you know, Lisa, our campaign earlier this year to raise the fi-nal $250,000 for the new pediatric rehab center was a great success. The commu-nity really turned out. Even after we paid the fundraising consultant, we cleared

more than $300,000 for the project. Your communications work on that was terrific, by the way.”

You mumble a “thank you” as Fred continues, his voice shaking a bit. “Un-fortunately, we learned earlier this week that there was a problem. It seems the con-sultant was a cousin of our CEO, and our CEO had a financial interest in his firm. An anonymous source—we believe it was his wife—called several members of the board and told them of the relationship. The board held a special meeting last night to ask him about the conflict, and he has resigned. We need a plan to communicate that internally and to the community.”

You manage to stammer, “Let me take some notes for a statement by the board chair,” as you reach for your briefcase.

“The board, of course, was very upset about this conflict of interest and the fact they didn’t know.”

You nod. “Well, of course. That should be in the statement.”

“Except that the chairman did know. He told the board he approved the hire because we needed to raise the money quickly or we’d lose a matching grant. In light of the situation, the board chair has resigned. And we need a plan to communicate that internally and to the community.

“That’s why Mrs. Marlowe is here,” Fred continues. “She’s the new board chair, and Victoria, our COO, is the new acting CEO.”

You look up from your notes. “Uh, do you think we ought to call everyone together and tell them all this in person? I’m afraid a statement may raise more ques-tions than it answers.”

“I agree, let’s do this face to face,” Mrs. Marlowe says. Delores Marlowe has been involved with the hospital for 40 years, first as a volunteer and now as a longtime board member. “And the other thing I worry about is, what do we do with the money we raised?”

“Mrs. Marlowe, I don’t think we need to go into that now,” the CFO interjects. “Let’s sit tight and see what happens.”

“No, now. I think we should announce that, given this terrible situation, we are returning all of the money to every donor.

We raised it under an ethical cloud. If they still want to donate it, they can.”

“Delores, if we do that we’ll lose the matching grant and delay the pediatric re-hab center by months, maybe even years. We have the money, and the community needs this!” the CFO says, rising from his chair. “Don’t bring up the money. Just tell everybody what we’ve done to deal with the conflict and the board issue, and keep moving ahead.”

“Lisa,” Fred says in an almost plead-ing tone. “We have to get in front of this fast. The hospital needs that pediatric re-hab service. But Mrs. Marlowe may be right—would the community feel as if they can’t trust us? Everything hinges on how we handle this.”

You roll your chair back. “What’s more important to the community here? That’s the issue.”

“So do we fess up but keep the money, or do we start writing checks to the do-nors?” the CFO says, her eyes narrowing.

If you were Lisa, which course of action would you recommend?

Comment on The Tightrope Walker #11 The scenario: A newly recruited phy-sician in a concealed-carry state has been observed packing heat on hospital property. Some doctors and nurses are demanding a ban on weapons in the hos-pital. Community sentiment is divided, and the issue is on the next board agenda. As the director of community relations, should you advise the CEO to ignore the issue, push for a hospital-wide weapons ban, or propose banning weapons in the OR and ER only?

Rick Wade says: The poll was unani-mous this time: 100 percent for the hospi-tal-wide weapons ban—obviously, the right answer for places whose mission is healing and in light of the incidents of violence that occur in hospitals. In the actual case this column is based on, the hospital adminis-trator (yes, that was his title) persuaded the board to delay the discussion. He let peer pressure from other doctors and nurses do the job, and the surgeon disarmed. A few weeks later, the hospital instituted the ban.

SHSMD

Register by July 31 and save $100. $795 for SHSMD members ($895 after July 31)$990 for nonmembers ($1,090 after July 31) (Nonmember fee includes a one-year SHSMD membership.)

Reserve your hotel room now to get the special SHSMD rate. Reservations: 800.835.5744 Room rate: $223 plus tax single/double Be sure to ask for the SHSMD rate when you reserve your room. The rate will apply until August 25 or until the room block is filled.

Visit www.shsmd.org in April to view the complete program and register online. Watch your mailbox in May for a print brochure and registration form.

Make plans now to join the conversation at the SHSMD Annual Conference—the biggest and best meeting of the year for healthcare strategy professionals.�

The Annual Conference Planning Committee is working hard to make the 2012 meeting the best one yet.� Here are just a few of the presenters we’ve lined up to enlighten and entertain you:

Thomas Goetz, executive editor of Wired magazine and author of The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine.

Ari Fleischer, CNN analyst and former White House press secretary to President George W. Bush

The Capitol Steps, the Washington-based troupe of congressional staffers turned songwriters

The SHSMD Annual Educational Conference and ExhibitsSeptember 19–22Philadelphia Marriott Downtown Philadelphia, PA